Second primary lung cancers following a diagnosis of primary head and neck cancer

Second primary lung cancers (SPLC) are not uncommon in survivors of squamous cell head and neck cancer (HNSCC), and carry a worse prognosis than when patients present with a primary lung cancer. We reviewed our institutional experience on the treatment and prognosis of SPLC patients, both at the time of diagnosis, and following treatment of HNSCC, in order to explore treatment outcomes.

Our institutional database was queried for patients with a diagnosis of HNSCC and lung cancer, between 2000 and 2013. Only HNSCC patients with tumors of the oral cavity, oropharynx, hypopharynx and larynx were eligible. Patients were stratified between synchronous and metachronous HNSCC and SPLC. Cox regression analysis was performed to determine factors predictive of overall survival (OS) in metachronous presentations.

181 eligible patients were identified for analysis, comprising 40 synchronous and 141 metachronous HNSCC-SPLC. Patients presenting with synchronous SPLC were more likely to have early-stage disease, as compared to patients with metachronous SPLC (45% vs. 28%, respectively; p=0.036). Patients with early stage SPLC had a significantly better survival compared to those with locally advanced (p<0.001) and metastatic disease (p<0.001), with a median OS of 95.4 months vs. 11.0 and 4.6 months, respectively.

Although the survival of patients treated for early-stage NSCLC were good, the OS of the entire cohort of SPLC after HNSCC was poor as a majority of patients presented with advanced disease. The use of CT screening strategies in this patient population warrants further investigation.